Efficacy and Safety of Rituximab in Autoimmune Disease-Associated Interstitial Lung Disease: A Prospective Cohort Study.

OBJECTIVES: To analyze the efficacy and safety of rituximab (RTX) in connective tissue disease associated with interstitial lung disease (CTD-ILD). METHODS: We performed a multicenter, prospective, observational study of patients with CTD-ILD receiving rituximab between 2015 and 2020. The patients were assessed using high-resolution computed tomography and pulmonary function tests at baseline, at 12 months, and at the end of follow-up. The main outcome measure at the end of follow-up was forced vital capacity (FVC) > 10% or diffusing capacity of the lungs for carbon monoxide (DLCO) > 15% and radiological progression or death. We recorded clinical characteristics, time to initiation of RTX, concomitant treatment, infections, and hospitalization. A Cox regression analysis was performed to identify factors associated with worsening ILD. RESULTS: We included 37 patients with CTD-ILD treated with RTX for a median (IQR) of 38.2 (17.7-69.0) months. At the end of the follow-up, disease had improved or stabilized in 23 patients (62.1%) and worsened in seven (18.9%); seven patients (18.9%) died. No significant decline was observed in median FVC (72.2 vs. 70.8; p = 0.530) or DLCO (55.9 vs. 52.2; p = 0.100). The multivariate analysis showed the independent predictors for worsening of CTD-ILD to be baseline DLCO (OR (95% CI), 0.904 (0.8-0.9); p = 0.015), time to initiation of RTX (1.01 (1.001-1.02); p = 0.029), and mycophenolate (0.202 (0.04-0.8); p = 0.034). Only 28 of the 37 patients (75.6%) were still undergoing treatment with RTX: two patients (5.4%) stopped treatment due to adverse events and seven patients (18.9%) died owing to progression of ILD and superinfection. CONCLUSION: Lung function improved or stabilized in more than half of patients with CTD-ILD treated with RTX. Early treatment and combination with mycophenolate could reduce the risk of progression of ILD.

Characteristics and Predictors of Progression Interstitial Lung Disease in Rheumatoid Arthritis Compared with Other Autoimmune Disease: A Retrospective Cohort Study.

OBJECTIVES: To describe the characteristics and progression of interstitial lung disease in patients with associated systemic autoimmune disease (ILD-SAI) and to identify factors associated with progression and mortality. PATIENTS AND METHODS: We performed a multicenter, retrospective, observational study of patients with ILD-SAI followed between 2015 and 2020. We collected clinical data and performed pulmonary function testing and high-resolution computed tomography at diagnosis and at the final visit. The main outcome measure at the end of follow-up was forced vital capacity (FVC) >10% or diffusing capacity of the lungs for carbon monoxide >15% and radiological progression or death. Cox regression analysis was performed to identify factors associated with worsening of ILD. RESULTS: We included 204 patients with ILD-SAI: 123 (60.3%) had rheumatoid arthritis (RA), 58 had (28.4%) systemic sclerosis, and 23 (11.3%) had inflammatory myopathy. After a median (IQR) period of 56 (29.8-93.3) months, lung disease had stabilized in 98 patients (48%), improved in 33 (16.1%), and worsened in 44 (21.5%). A total of 29 patients (14.2%) died. Progression and hospitalization were more frequent in patients with RA (p = 0.010). The multivariate analysis showed the independent predictors for worsening of ILD-SAI to be RA (HR, 1.9 [95% CI, 1.3-2.7]), usual interstitial pneumonia pattern (HR, 1.7 [95% CI, 1.0-2.9]), FVC (%) (HR, 2.3 [95% CI, 1.4-3.9]), and smoking (HR, 2.7 [95%CI, 1.6-4.7]). CONCLUSION: Disease stabilizes or improves after a median of 5 years in more than half of patients with ILD-SAI, although more than one-third die. Data on subgroups and risk factors could help us to predict poorer outcomes.

Neurosarcoidosis: análisis de una serie de 20 pacientes / Neurosarcoidosis: Analysis of a series of 20 patients

INTRODUCCIÓN: La neurosarcoidosis es una rara complicación de la sarcoidosis. Existen series cortas de pacientes con esta afectación. En España son prácticamente inexistentes. Planteamos realizar un estudio retrospectivo sobre neurosarcoidosis en el Hospital Virgen de la Victoria a lo largo de 10 años. PACIENTES Y MÉTODOS: Búsqueda en la base de datos hospitalaria de los pacientes con este diagnóstico en los últimos 10 años. RESULTADOS: Ciento veinte pacientes con sarcoidosis, de los cuales 20 pacientes compatibles con neurosarcoidosis probable: el 30% fue inicio de la enfermedad, el 55% ya estaban diagnosticados de sarcoidosis y el 15% tuvieron neurosarcoidosis aislada. El 40% presentaron polineuropatía, el 15% neuropatía craneal, el 15% miopatía y el 10% focalidad del sistema nervioso central. Otros: Cefalea, mielitis, crisis epiléptica y cuadro confusional. Se trataron con esteroides, y a veces se asociaron otros inmunosupresores. El 72% de los casos se estabilizaron o hubo mejoría. Por tanto, la prevalencia de neurosarcoidosis en nuestro hospital es del 11%, parecido a otras series publicadas, con características similares, pero con mayor frecuencia de polineuropatía. El pronóstico de la enfermedad es aceptablemente favorable con tratamiento, por lo que es importante el diagnóstico precoz

INTRODUCTION: Neurosarcoidosis is a rare complication of sarcoidosis. There are small series on the condition and very few from Spain. We conducted a retrospective study of neurosarcoidosis in Virgen de la Victoria Hospital over the last 10 years. PATIENTS AND METHOD: the medical records of patients diagnosed with sarcoidosis in our setting in the last 10 years were reviewed. RESULTS: One hundred twenty patients with sarcoidosis, 20 patients with probable neurosarcoidosis: 30% at the beginning of the illness, 55% later, 15% had isolated neurosarcoidosis. Forty percent had polyneuropathy, 15% cranial neuropathy, 15% myopathy, 10% hemispheric symptoms. Others: headache, myelitis, seizures, confusional syndrome. They were treated with steroids, some of them with immunosuppressive treatment. Seventy-two percent improved or were stabilized. Therefore, neurosarcoidosis prevalence in our hospital was 11%, similar to other published series, with similar features, but polyneuropathy was more frequent. Early diagnosis is very important as prognosis is favourable with treatment

Neurosarcoidosis: Analysis of a series of 20 patients. / Neurosarcoidosis: análisis de una serie de 20 pacientes.

INTRODUCTION: Neurosarcoidosis is a rare complication of sarcoidosis. There are small series on the condition and very few from Spain. We conducted a retrospective study of neurosarcoidosis in Virgen de la Victoria Hospital over the last 10 years. PATIENTS AND METHOD: the medical records of patients diagnosed with sarcoidosis in our setting in the last 10 years were reviewed. RESULTS: One hundred twenty patients with sarcoidosis, 20 patients with probable neurosarcoidosis: 30% at the beginning of the illness, 55% later, 15% had isolated neurosarcoidosis. Forty percent had polyneuropathy, 15% cranial neuropathy, 15% myopathy, 10% hemispheric symptoms. OTHERS: headache, myelitis, seizures, confusional syndrome. They were treated with steroids, some of them with immunosuppressive treatment. Seventy-two percent improved or were stabilized. Therefore, neurosarcoidosis prevalence in our hospital was 11%, similar to other published series, with similar features, but polyneuropathy was more frequent. Early diagnosis is very important as prognosis is favourable with treatment.

Mucormicosis pulmonar en paciente joven con inicio de diabetes mellitus / Pulmonary mucormycosis at onset of diabetes in a young patient

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Fiebre mediterránea familiar en tratamiento con anakinra: a propósito de un caso / Familial mediterranean fever treated with anakinra: a case report

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Precisión del diagnóstico en medicina interna e influencia de un sistema informático en el razonamiento clínico / The accuracy of the diagnosis in internal medicine and the influence of a computerised system on clinical reasoning

INTRODUCCIÓN: El contacto inicial entre paciente y médico es clave para plantear un diagnóstico diferencial. Este proceso está basado en la experiencia y en la recuperación de patrones almacenados en el cerebro. Un problema importante es la limitación de la memoria, por lo que un sistema electrónico de sugerencia de posibilidades podría ser de utilidad. OBJETIVOS: Conocer la precisión diagnóstica de un grupo de internistas interaccionando con un sistema informático de apoyo al diagnóstico (SIAD). Conocer el grado de acuerdo entre los clínicos y el SIAD en su capacidad para enumerar un correcto diagnóstico inicial. Pacientes y MÉTODO: estudio prospectivo realizado en un hospital general en Málaga, en el que se mide la precisión diagnóstica para clínicos y SIAD en una muestra de 50 pacientes. RESULTADOS: La precisión diagnóstica de los clínicos fue del 60% y la del SIAD, del 72% (diferencia no significativa). La concordancia entre ambos fue baja (kappa = 0,33). CONCLUSIÓN: Los clínicos y el SIAD tienen similar precisión diagnóstica inicial, pero una baja concordancia, lo que puede evidenciar un comportamiento operativo diferente

INTRODUCTION: The first contact between a physician and a patient is a key moment to establishing a differential diagnosis. This process is based on experience and recovery of patterns stored in the brain. One important problem is the limitation of memory, thus a computerised system that suggests possibilities could be of use in establishing a differential diagnosis. OBJECTIVES: To determine the diagnostic accuracy of a group of internists working with an Electronic Diagnostic Reminder Tool (EDRT). To measure the agreement between clinicians and the EDRT in the initial diagnostic work. PATIENTS AND METHOD: A prospective study was conducted in a general hospital in Málaga, Spain. The diagnostic accuracy of clinicians and the EDRT was recorded on a sample of 50 PATIENTS: RESULTS: The diagnostic accuracy for clinicians was 60%, and for the EDRT it was 72%, with a low agreement (kappa = 0.33). CONCLUSIÓN: Clinicians and the EDRT have a similar diagnostic accuracy, but a low level of concordance, showing a different operational behaviour

Incidencia de cáncer en una cohorte de pacientes con lupus eritematoso sistémico / Rheumatology in the community of Madrid: current availability of rheumatologists and future needs using a predictive model

Objetivo. Determinar la incidencia y prevalencia del cáncer en una cohorte de pacientes con lupus eritematoso sistémico (LES) e identificar los factores de riesgo asociados. Pacientes y métodos. El estudio incluyó una cohorte dinámica de los pacientes con LES (de noviembre de 1989 a diciembre del 2006) en un centro hospitalario de tercer nivel. Se utilizó un control externo ajustado por edad y sexo a través de un registro hospitalario de tumores de la misma área sanitaria. Resultados. El estudio incluyó a 175 pacientes con LES (90% mujeres), con un tiempo en riesgo de 1370,5 pacientes-año. Catorce mujeres (8%) murieron, principalmente por eventos cardiovasculares. Ningún paciente falleció por tumor maligno. Se encontraron 35 tumores en 28 pacientes, 25 de ellos después del diagnóstico de LES, de los cuales 5 fueron malignos. La tasa de tumores benignos fue de 14,6/1000 pacientes-año (IC del 95%, 8,9–22,5) y de los tumores malignos 3,6/1000 pacientes-año (IC del 95%, 1,5 a 8,8), con una razón de momios de incidencia cruda para los tumores malignos de 3,5 (IC del 95%, 01,05 a 07,09). Sin embargo, esta significación se perdió cuando se estandarizaron las tasas. En cuanto a los factores de riesgo asociados, se encontraron diferencias en la velocidad de sedimentación globular media (HR 1,4 [1,1–1,7]), y la presencia de trombosis (HR 6,9 [1,49 a 41,2]), en especial la trombosis arterial. Conclusiones. Encontramos una tasa cruda de incidencia de cáncer casi 4 veces mayor en los pacientes con LES en comparación con la tasa esperada en nuestra área de influencia del hospital (zona oeste de Málaga) (AU)

Objective: To determine the incidence and prevalence of cancer in a cohort of patients with systemic lupus erythematosus (SLE) and identify associated risk factors. Patients and methods: The study comprised a dynamic cohort of SLE patients (November 1989 to December 2006) at a tertiary referral centre. An adjusted external control from the hospital tumour registry was used. Results: The study included 175 SLE patients (90% women), with a mean time at risk of 1370.5 patientyears. Fourteen women (8%) died, mainly from cardiovascular events. No patient died due to malignancy. We found 35 tumours in 28 patients, 25 of them after the diagnosis of SLE, of which 5 were malignant. The rate of benign tumours was 14.6/1000 patient-years (95% CI, 8.9–22.5) and of malignant tumours 3.6/1000 patient-years (95% CI, 1.5–8.8), with a crude incidence odds ratio for malignant tumours of 3.5 (95% CI, 1.5–7.9). However, this significance was lost after standardizing the rates. Concerning associated risk factors, differences were found in the mean erythrocyte sedimentation rate [HR 1.4 (1.1–1.7)], and the presence of thrombosis [HR 6.9 (1.49–41.2)], especially arterial thrombosis. Conclusions: We found a crude incidence rate of cancer that was almost four times greater in our SLE patients as compared with the expected rate in the hospital area of western Malaga (AU)

Incidence of cancer in a cohort of Spanish patients with systemic lupus erythematosus.

OBJECTIVE: To determine the incidence and prevalence of cancer in a cohort of patients with systemic lupus erythematosus (SLE) and identify associated risk factors. PATIENTS AND METHODS: The study comprised a dynamic cohort of SLE patients (November 1989 to December 2006) at a tertiary referral centre. An adjusted external control from the hospital tumour registry was used. RESULTS: The study included 175 SLE patients (90% women), with a mean time at risk of 1370.5 patient-years. Fourteen women (8%) died, mainly from cardiovascular events. No patient died due to malignancy. We found 35 tumours in 28 patients, 25 of them after the diagnosis of SLE, of which 5 were malignant. The rate of benign tumours was 14.6/1000 patient-years (95% CI, 8.9-22.5) and of malignant tumours 3.6/1000 patient-years (95% CI, 1.5-8.8), with a crude incidence odds ratio for malignant tumours of 3.5 (95% CI, 1.5-7.9). However, this significance was lost after standardizing the rates. Concerning associated risk factors, differences were found in the mean erythrocyte sedimentation rate [HR 1.4 (1.1-1.7)], and the presence of thrombosis [HR 6.9 (1.49-41.2)], especially arterial thrombosis. CONCLUSIONS: We found a crude incidence rate of cancer that was almost four times greater in our SLE patients as compared with the expected rate in the hospital area of western Malaga.